An Angioplasty, also known as a Percutaneous Transluminal Coronary Angioplasty (PTCA) is an emergency procedure - a balloon-tipped catheter is used to enlarge a blocked artery, restoring blood flow. Patients requiring an angioplasty should receive the emergency procedure within 90 minutes of arriving in hospital.
The period from arriving in hospital to starting an angioplasty is known as D2B (door-to-balloon) time. For those with STEMI (ST-segment elevation myocardial infarction) - caused by a complete blood supply blockage to the heart - prompt action is crucial. Approximately 250,000 Americans suffer this kind of heart attack annually.
In what the authors describe as one of the most comprehensive studies of angioplasty promptness, the researchers found that:
- 91% of patients were treated within 90 minutes of arriving in hospital in 2010
- 44% of patients were treated within 90 minutes of arriving in hospital in 2005
- 70% underwent angioplasty within 75 minutes in 2010
- 27% underwent angioplasty within 75 minutes in 2005
- The median D2B time for angioplasty dropped from 96 minutes in 2005 to 64 minutes in 2010
"Everybody had to improve to get a national report card like this. This remarkable improvement demonstrates what we can achieve when we work together and is a tribute to the doctors, nurses and other healthcare professionals that applied the information from the research studies about how best to deliver care to ensure that patients are treated rapidly."
Dr. Krumholz and team gathered and analyzed hospital data from the Centers for Medicare & Medicaid Services (CMS) from over 300,000 individuals who underwent emergency angioplasty. The data also included those without Medicare coverage.
According to the authors, the improvement is a result of a nationwide effort between doctors, healthcare organizations, and federal agencies.
Among the initiatives that contributed to the improvement, are:
- Hospital Compare - the percentage of patients treated within recommended times was publicly published. Launched in 2005, this was part of CMS' program.
- D2B Alliance - advocating the adoption of proven strategies to reduce delays, based on a National Heart, Lung, and Blood Institute funded study. It was launched by the American College of Cardiology, along with national partners to improve D2B times.
- Mission: Lifeline - launched by the American Heart Association in 2007. Its aim is to improve community-wide care systems for STEMI patients. Included are ways to get patients to call 911 faster, improve capabilities of emergency teams and response times, provide faster triage and transportation from hospitals that do not provide the procedure to those that do.
"The findings of this study are remarkable in that there has been a dramatic improvement in timely care of heart attacks across the entire country. It shows what can be accomplished with systematic quality improvement efforts based on sound evidence. The results of this study reinforce the value of ongoing efforts to extend these improvements to emergency medical services, networks of hospitals and to all aspects of care of heart attacks, as is now being done in Mission: Lifeline."
"At the beginning of these efforts, many said that this level of improvement was impossible to achieve. This is an opportunity to reflect on our achievement and to recognize that, when we identify quality issues and problems in our healthcare system, we can work as a community to generate new knowledge to apply to practice and improve care for patients."